Antall József szerk.: Orvostörténeti közlemények 55-56. (Budapest, 1970)

TANULMÁNYOK - Regöly-Mérei, Gyula: The Pathological Reconstruction of Semmelweis's Disease on the Basis of the Catamnestic Analysis and Palaeopathological Examination (angol nyelvű közlemény)

and, therefore, references to be found in literature according to which he only dealt with secondary symptoms, is erroneous. Bonhoeffer described the exogenous reaction type (11) in 1910. According to the latter its characteristics are delirium, infectious cloudy state, confusion of the mind, the narrowing down of consciousness, incoherent behaviour, possibly epileptiform state of excitement and sometimes hallucinations. These may be caused by acute infectious diseases, chronical toxicosis and septic diseases as well. In the opinion of Wyrsch (76) it is a characteristic sign that — during the lucid intervals — a patient does not recollect the abnormal occurrences. In the view of Haranghy, Nyirő and Regöly-Mérei, however, Semmelweis's disease corresponds to Bonhoeffer's acute infectious-bacterium toxinic reaction type (mainly of delirious character), that is, his disease cannot be considered a genuine mental disorder, especially paralysis progressiva. Bonhoeffer's reaction type fully accounts for the symptoms observed in the case of Semmelweis (e.g. periodical confusion of the mind, incoherence etc.) and the other symptoms as well (e.g. mood lability, use of obscene words, bulimia etc.) — which, besides, are not pathognomonic of paralysis but can at most occur in the case of the latter too. Literature (7) also deals with the question why Semmelweis, as matters stood, had to be taken to a lunatic asylum; how was it possible that eminent physicians, such as Balassa a surgeon, Wagner an internist, further Markusovszky and Bókay did not weigh the case carefully and think it well over for in the middle of the last century septic diseases and disorders of the nervous system due to the former occured frequently. Contemporary special literature on surgery (5, 46, etc.) was in fact, aware that various acute infectious diseases further septic diseases can cause psychotic symptoms such as delirium and a cloudy state of mind, however somnolence was considered at that time the most characteristic symptom of all. In the Pest period of Semmelweis's disease such symptoms (somnolence) were not observable but periodicity i.e. serious psychic symptoms alternating with lucid intervals manifested themselves. This phenomenon, however, was only described in the 20th century. On the basis of the then known symptoms Balassa, Wagner, Markusovszky and Bókay could not even think of this possibility. X. THE PATHOLOGICAL RECONSTRUCTION 1. In accordance with the opinion of Schaffer and Nyirő as expounded above, no data could be found in the course of the catamnestic analysis on the basis of which abnormal psychic condition could be assumed in the praemorbid phase. The tone used in the debates is not abnormal but the result of his normal physiological psychical constitution. 2. Data pointing to syphilis could not be found either in the catamnesis, the autopsy report, the neurohistological finding or in the evaluation of the palaeopathological and X-ray examinations.